ICU病原菌的分布特征及耐药性分析

Distribution and drug resistance of common pathogenic bacteria in intensive care unit

目的探讨重症监护病房(ICU)病原菌的分布特征及耐药性变化趋势,为临床合理使用抗菌药物提供理论依据。方法回顾性分析2009年1月-2011年12月ICU患者送检标本分离的病原菌及其耐药性。结果共分离出病原菌2255株,其中革兰阴性菌1628株占72.2%,革兰阳性菌627株占27.8%;前5位依次为铜绿假单胞菌、嗜麦芽寡养单胞菌、金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌,分别占22.0%、12.8%、10.3%、9.5%、8.9%;铜绿假单胞菌及鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药率>60.0%,泛耐药铜绿假单胞菌及鲍氏不动杆菌的检出率分别为14.9%和26.0%;大肠埃希菌对大多数抗菌药物耐药率>50.0%,产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为70.0%和35.0%;耐甲氧西林金黄色葡萄球菌(MRSA)与表皮葡萄球菌(MRSE)的检出率分别为89.7%和82.1%,未发现耐万古霉素葡萄球菌,但粪肠球菌和类粪肠球菌中分别有3.6%对万古霉素耐药。结论非发酵菌、金黄色葡萄球菌、肺炎克雷伯菌及大肠埃希菌是ICU患者感染的常见病原菌,且病原菌的耐药性非常严重,必须采取行之有效的方法加以控制。

OBJECTIVE To investigate the distribution and drug resistance of the common pathogenic bacteria in the patients of intensive care unit so as to provide theoretical bases for clinical rational use of antibiotics. METHODS The pathogens isolated from the specimens that were obtained from the ICU patients from Jan 2009 to Dec 2011 were retrospectively analyzed. RESULTS A total of 2255 strains of pathogens were isolated , including 1628 （72.2%）strains of gram-negative bacteria and 627（27. 8%）strains of gram-positive bacteria; the Pseudomonas aeruginosa （495 strains, 22.0%）, Stenotrophomonas maltophilia （289 strains, 12.8%）, Staphylococcus aureus （232 strains, 10.3%）, Acinetobacter baumannii （215 strains, 9.5o//00） and Klebsiella pneumoniae （201 strains, 8.9 %） ranked the top five species of pathogens. The drug resistance rates of P. aeruginosa and A. baumannii to carbapenems antibiotics were more than 60.0%. The detection rates of the pandrug-resistant P. aeruginosa and A. baumannii were 14. 9% and 26.0%, respectively. More than 50.0% of E. coli were resistant to most of antihacterials monitored, the detection rates of ESBLs-produeing E. coli and K. pneumonia were 70. 0% and 35.0%, respectively; the detection rates of the methicillin-resistant S. aureus and S. epidermidis were 89.7% and 82. 1%, respectively, no strains of vancomycin-resistant Staphylococcus strains were found, but the drug resistance rates of Enterococcus faecalis and Enterococcus faecalis to vancomycin were 3.6 0/~. CONCLUSION The non-fermenting bacteria, S. aureus,K, pneumoniae and E. coli are the predominant pathogens causing infections in the ICU patients, and the strains are so resistant that it is necessary to take effective control measures.